Back to Journals » Vascular Health and Risk Management » Volume 15

When to withhold oral anticoagulation in atrial fibrillation – an overview of frequent clinical discussion topics

Authors Seelig J, Pisters R, Hemels ME, Huisman MV, ten Cate H, Alings M

Received 28 June 2019

Accepted for publication 28 August 2019

Published 17 September 2019 Volume 2019:15 Pages 399—408


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Magnus Bäck

Jaap Seelig,1 Ron Pisters,1 Martin E Hemels,1,2 Menno V Huisman,3 Hugo ten Cate,4,5 Marco Alings6

1Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands; 2Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands; 3Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands; 4Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; 5Anticoagulation Clinic Maastricht, Maastricht, The Netherlands; 6Department of Cardiology, Amphia Hospital, Breda, The Netherlands

Correspondence: Martin E Hemels
Department of Cardiology, Rijnstate Hospital, Wagnerlaan 55, Arnhem, AD 6815, The Netherlands
Tel +31 64 126 8279
Email [email protected]

Abstract: Stroke prevention with oral anticoagulants in patients with atrial fibrillation predisposes for bleeding. As a result, in select patient groups anticoagulation is withheld because of a perceived unfavorable risk-benefit ratio. Reasons for withholding anticoagulation can vary greatly between clinicians, often leading to discussion in daily clinical practice on the best approach. To guide clinical decision-making, we have reviewed available evidence on the most frequently reported reasons for withholding anticoagulation: previous bleeding, frailty and age, and an overall high bleeding risk.

Keywords: hemorrhage, frail elderly, age, anticoagulants, atrial fibrillation

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]